Excerpt

Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction. It is characterised by rapidly developing, life-threatening problems involving: the airway (pharyngeal or laryngeal oedema) and/or breathing (bronchospasm with tachypnoea) and/or circulation (hypotension and/or tachycardia). In most cases, there are associated skin and mucosal changes.

In emergency departments a person who presents with the signs and symptoms listed above may be classified as having a ‘severe allergic’ reaction rather than an ‘anaphylactic’ reaction. Throughout this guideline, anyone who presents with such signs and symptoms is classed as experiencing a ‘suspected anaphylactic reaction’, and should be diagnosed as having ‘suspected anaphylaxis’.

People who have had a mild or moderate allergic reaction are at risk of, and may subsequently present with, suspected anaphylaxis. Certain groups may be at higher risk, either because of an existing comorbidity (for example asthma) or because they are more likely to be exposed to the same allergen again (for example people with venom allergies or reactions to specific food triggers). These groups were not included within the scope of this guideline, which is specific to those who have received emergency treatment for suspected anaphylaxis.

Contents

• Introduction
• Patient-centred care
• 1. Recommendations
  • 1.1. List of all recommendations
• 2. Care pathway
• 3. Evidence review and recommendations
  • 3.1. Use and timing of mast cell tryptase testing in the anaphylaxis diagnostic pathway
  • 3.2. Duration of observation after a suspected anaphylactic reaction
  • 3.3. Assessment and the decision to refer after a suspected anaphylactic reaction
  • 3.4. Patient information after a suspected anaphylactic reaction
  • 3.5. Models of care for the diagnosis of anaphylaxis
• 4. Notes on the scope of the guideline
• 5. Implementation
• 6. Other versions of this guideline
  • 6.1. NICE pathway
  • 6.2. ‘Understanding NICE guidance’
• 7. Related NICE guidance
• 8. Updating the guideline
• 9. References
• 10. Glossary and abbreviations
  • Glossary
• Appendix A. Contributors and declarations of interests
• Appendix B. List of all research recommendations
• Appendix C. Guideline scope
• Appendix D. How this guideline was developed
• Appendix E. Evidence tables
• Appendix F. Full health economic report
• Appendix G. Technical assessment report (sections 3.3.2 and 3.3.4)

NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales.

This guidance represents the view of NICE, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, and informed by the summary of product characteristics of any drugs they are considering.

Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.